Medicines Use Review [MUR]. Liz Stafford LPC/PCT liaison. Outline. Context Understanding potential benefits of MURs Identifying potential barriers & how to overcome them Good practice examples Key Success Factors. Context. NHS Community Pharmacy contract 2004.
- Advanced tier
- Requires accreditation of pharmacist & premises
Help people use their medicines more effectively
Repeat prescription list & patient interview
Mostly technical issues that can be actioned by pharmacist/patient
Some patients referred for more detailed clinical review
Clinical Medication Review:
Enable patients to get the most effective & appropriate treatment for them
Full medical history and patient interview
A concordance based review to which the patient is asked to bring all their medication (including purchased medicines) :
- misunderstanding the treatment (or condition)
- patients’ beliefs
- lack of social support
- fear, or experience of, side-effects
- complex regimen ; frequent dosing; method of administration
- no, or mild, symptoms ; sever symptoms
Around 50% of patients do not comply with some element of prescribed treatment; a large proportion of GP appointments are taken by patients with long term conditions; and a high proportion of hospital re-admissions in the elderly are a direct result of poor compliance with prescribed medication.
- improved health outcomes & quality of life
- encourages self care ; ownership of condition & treatment
- reduction in secondary care admissions
- cost savings from prescribing budget i.e. waste, efficiencies.
- can save time and can improve quality of QOF reviews and clinical reviews if MUR is done first.
- opportunity to integrate care pathways as part of service redesign
- opportunity to support “long term conditions” closer to home
- not well communicated, nor understood, nor designed.
- development of new patient facilities/ consultation rooms
- pharmacist accreditation with HEI
- pharmacist workload / delivery of new contract
- development of support staff
- re-engineering of community pharmacy practice.
- terminology “ Medicines Check Up”
- Prior to annual medical reviews
- From “fallers” units in hospitals
- Via community matrons, district nurses, social services, etc.
- For care home and housebound patients
When MUR was sent to GP practice it was discovered that the patient was not flagged as an asthmatic.
This enables GPs to gain QOF payment.
The next level of service involves providing the pharmacist with more information from the GP practice so they can assess symptom control, provide specific health promotion & referrals.
- Pharmacist carries out MUR just before referring patient back to the GP for their next annual review, so that GP has MUR information at this point.
- Pharmacist could also remind patient when blood tests, etc. are required (if GP attaches this information to RD request)